Estimating the effect of emergency care on early survival after traffic crashes.
Estimating the effect of emergency care on early survival after traffic crashes.
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DOI：
10.1016/j.aap.2013.08.019
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发表时间：
2013-11
期刊：
影响因子：
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通讯作者：
D. Clark;R. Winchell;R. Betensky
中科院分区：
文献类型：
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作者：
D. Clark;R. Winchell;R. Betensky
简介农村地区的交通事故死亡率较高，但尚不清楚这是否是由于伤害严重程度较高、时间延误或紧急医疗服务 (EMS) 不足所致。方法 2002 年至 2003 年的数据来自死亡分析报告系统 (FARS) 和国家汽车采样系统 (NASS) 耐撞性数据系统 (CDS) 的“扩展版本”。估计生存时间 (tSURV) 的加权 Cox 和 Weibull 模型，时变协变量 (TVC) 在 EMS 到达时间 (tEMS) 和医院到达时间 (tHOS) 之后的指定时间间隔内具有恒定影响。 Weibull 模型通过 tSURV 间隔审查重复，以反映确切死亡时间的不确定性，使用插补方法来适应间隔审查和 TVC。 结果 FARS 包含 92,718 名致命或失能受伤人员的记录，NASS/CDS 包含 5517 名失能受伤人员（加权人口为 642,716）。所有模型都将死亡率与年龄增长、男性、不使用安全带、更高的速度和车辆侧翻联系起来。间隔删失模型将 EMS 干预与有益效果相关联，直至 EMS+ 30 分钟，但此后则不然；医院干预与随着时间的推移而增加的强烈有益效果相关。农村地区与较高的基线危险相关；理论上，农村院前时间减少 50% 可使 4 小时死亡率降低约 7%。 结论 城乡事故死亡率差异主要与时间延迟和 EMS 效应无关。然而，TVC 生存模型支持 EMS 护理“黄金时刻”的临床直觉，以及及时送往医院的重要性。
IntroductionTraffic crash mortality is higher in rural areas, but it is unclear whether this is due to greater injury severity, time delays, or Emergency Medical Services (EMS) deficiencies.MethodsData from 2002–2003 were combined from the Fatality Analysis Reporting System (FARS) and an “expanded version” of the National Automotive Sampling System (NASS) Crashworthiness Data System (CDS). Weighted Cox and Weibull models for survival time (tSURV) were estimated, with time-varying covariates (TVC) having constant effects for specified time intervals following EMS arrival time (tEMS) and hospital arrival time (tHOS). The Weibull model was repeated withtSURVinterval-censored to reflect uncertainty about the exact time of death, using an imputation method to accommodate interval censoring along with TVC.ResultsFARS contained records for 92,718 persons with fatal or incapacitating injuries, and NASS/CDS contained 5517 (weighted population of 642,716) with incapacitating injuries. All models associated mortality with increasing age, male sex, belt nonuse, higher speeds, and vehicle rollover. The interval-censored model associated EMS intervention with a beneficial effect untiltEMS+ 30 min, but not thereafter; hospital intervention was associated with a strongly beneficial effect that increased with time. Rural location was associated with a higher baseline hazard; a 50% reduction in rural prehospital time would theoretically reduce 4-h mortality by about 7%.ConclusionRural/urban disparity in crash mortality is mostly independent of time delays and EMS effects. However, survival models with TVC support clinical intuition of a “golden hour” in EMS care, and the importance of timely transport to a hospital.